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01-10-2010 | Original Paper

Predictability of cerebral palsy and its characteristics through neonatal cranial ultrasound in a high-risk NICU population

Authors: Eveline Himpens, Ann Oostra, Inge Franki, Georges Van Maele, Piet Vanhaesebrouck, Christine Van den Broeck

Published in: European Journal of Pediatrics | Issue 10/2010

Abstract

The aim of the study is to evaluate the predictive value of various types of brain injury detected by ultrasound in the neonatal period for the occurrence of cerebral palsy and its characteristics in a large cohort of high-risk infants. Thousand twenty-one consecutively NICU-admitted high-risk infants were assessed up to the corrected age of at least 2 years. Cerebral palsy (CP) was categorised into spastic or non-spastic, bilateral or unilateral and mild, moderate or severe CP. Different types of brain injury were identified by serial cranial ultrasound (US) during the NICU stay: white matter disease (WMD), haemorrhage, cerebral infarction, deep grey matter and parasagittal cerebral injury. There is a significant overall association between different types of brain injury and gestational age. Only 4% of the children with normal US develop CP. In the presence of any abnormal US image, the likeliness to develop CP is at least seven times higher. Within the group of infants with WMD and haemorrhage, the degree of brain involvement has a clear impact on the occurrence of CP. Concerning the characteristics of CP, deep grey matter lesion predict non-spastic CP versus spastic CP (OR = 31, P < 0.001). Cerebral infarction and haemorrhage grade IV are strong predictors of unilateral spastic CP versus bilateral spastic CP (OR = 49 and 24, respectively, P < 0.001). Deep grey matter lesion is a significant predictor for severe versus mild and moderate CP (OR = 6). In conclusion, neonatal cranial US is a useful tool in predicting CP and its characteristics.

Surveillance of Cerebral Palsy in Europe (SCPE) (2000) Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers. Dev Med Child Neurol 42:816–824CrossRef

Himpens E, Van den Broeck C, Oostra A et al (2008) Prevalence, type, distribution, and severity of cerebral palsy in relation to gestational age: a meta-analytic review. Dev Med Child Neurol 50:334–340CrossRefPubMed

Ancel PY, Livinec F, Larroque B et al (2006) Cerebral palsy among very preterm children in relation to gestational age and neonatal ultrasound abnormalities: the EPIPAGE cohort study. Pediatrics 117:828–835CrossRefPubMed

Himpens E, Oostra A, Franki I et al (2010) Influence of gestational age on nosologic CP characteristics in a high-risk population. Eur J Pediatr 169(3):305–310. doi:10.1007/s00431-009-1026-9 [doi]CrossRefPubMed

Okumura A, Hayakawa F, Kato T et al (1997) MRI findings in patients with spastic cerebral palsy.1. Correlation with gestational age at birth. Dev Med Child Neurol 39:363–368CrossRefPubMed

Barkovich J (2000) Pediatric Neuroimaging, 3rd edn. Raven Press

Volpe JJ (2001) Hypoxic-ishemic encephalopathy. In neurology of the newborn, 4th edn. W.B. Saunders CO, Philadelphia

Korzeniewski SJ, Birbeck G, Delano MC et al (2008) A systematic review of neuroimaging for cerebral palsy. J Child Neurol 23:216–227CrossRefPubMed

De Vries LS, Van Haastert IL, Rademaker KJ et al (2004) Ultrasound abnormalities preceding cerebral palsy in high-risk preterm infants. J Pediatr 144:815–820PubMed

10.

Kuban KCK, Allred EN, O'Shea TM et al (2009) Cranial ultrasound lesions in the NICU predict cerebral palsy at age 2 years in children born at extremely low gestational age. J Child Neurol 24:63–72CrossRefPubMed

11.

Mirmiran M, Barnes PD, Keller K, Constantinou JC et al (2004) Neonatal brain magnetic resonance imaging before discharge is better than serial cranial ultrasound in predicting cerebral palsy in very low birth weight preterm infants. Pediatrics 114:992–998CrossRefPubMed

12.

Woodward LJ, Anderson PJ, Austin NC et al (2006) Neonatal MRI to predict neurodevelopmental outcomes in preterm infants. N Engl J Med 355:685–694CrossRefPubMed

13.

Horsch S, Skiold B, Hallberg B et al. (2009) Cranial ultrasound and MRI at term age in extremely preterm infants. Arch Dis Child Fetal Neonatal Ed. adc.2009.161547 [pii];10.1136/adc.2009.161547 [doi]

14.

Balf CL, Ingram TTS (1955) Problems in the classification of cerebral palsy in childhood. Br Med J 2:163–166CrossRefPubMed

15.

Wichers MJ, van der Schouw YT, Moons KGM et al (2001) Prevalence of cerebral palsy in The Netherlands (1977–1988). Eur J Epidemiol 17:527–532CrossRefPubMed

16.

De Vries LS, Eken P, Groenendaal F et al (1993) Correlation between the degree of periventricular leukomalacia diagnosed using cranial ultrasound and MRI later in infancy in children with cerebral palsy. Neuropediatrics 24:263–268CrossRefPubMed

17.

Papile LA, Burstein J, Burstein R, Koffler H (1978) Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1, 500 gm. J Pediatr 92:529–534CrossRefPubMed

18.

Glas AS, Lijmer JG, Prins MH et al (2003) The diagnostic odds ratio: a single indicator of test performance. J Clin Epidemiol 56:1129–1135CrossRefPubMed

19.

Allan WC, Vohr B, Makuch RW et al (1997) Antecedents of cerebral palsy in a multicenter trial of indomethacin for intraventricular hemorrhage—reply. Arch Pediatr Adolesc Med 151:1270

20.

Holling EE, Leviton A (1999) Characteristics of cranial ultrasound white-matter echolucencies that predict disability: a review. Dev Med Child Neurol 41:136–139CrossRefPubMed

21.

Graham M, Levene MI, Trounce JQ, Rutter N (1987) Prediction of cerebral-palsy in very-low-birth-weight infants—prospective ultrasound study. Lancet 2:593–596CrossRefPubMed

22.

Appleton RE, Lee REJ, Hey EN (1990) Neurodevelopmental outcome of transient neonatal intracerebral echodensities. Arch Dis Child 65:27–29CrossRefPubMed

23.

De Vries LS, Regev R, Pennock JM et al (1988) Ultrasound evolution and later outcome of infants with periventricular densities. Early Hum Dev 16:225–233CrossRefPubMed

24.

Fawer CL, Diebold P, Calame A (1987) Periventricular leucomalacia and neurodevelopmental outcome in preterm infants. Arch Dis Child 62:30–36CrossRefPubMed

25.

Resch B, Jammernegg A, Perl E et al (2006) Correlation of grading and duration of periventricular echodensities with neurodevelopmental outcome in preterm infants. Pediatr Radiol 36:810–815CrossRefPubMed

26.

Patra K, Wilson-Costello D, Taylor HG et al (2006) Grades I-II intraventricular hemorrhage in extremely low birth weight infants: effects on neurodevelopment. J Pediatr 149:169–173CrossRefPubMed

27.

De Vries LS (1996) Neurological assessment of the preterm infant. Acta Paediatr 85:765–771CrossRefPubMed

28.

Roth SC, Baudin J, Pezzanigoldsmith M et al (1994) Relation between neurodevelopmental status of very preterm infants at one and 8 years. Dev Med Child Neurol 36:1049–1062CrossRefPubMed

29.

Ment LR, Schneider KC, Ainley MA, Allan WC (2000) Adaptive mechanisms of developing brain—the neuroradiologic assessment of the preterm infant. Clin Perinatol 27:303–323CrossRefPubMed

30.

Pintomartin JA, Riolo S, Cnaan A et al (1995) Cranial ultrasound prediction of disabling and nondisabling cerebral-palsy at age-2 in a low-birth-weight population. Pediatrics 95:249–254

31.

Bax M, Tydeman C, Flodmark O (2006) Clinical and MRI correlates of cerebral palsy—The European Cerebral Palsy Study. Jama 296:1602–1608CrossRefPubMed

32.

Palmer FB (2004) Strategies for the early diagnosis of cerebral palsy. J Pediatr 145:S8–S11CrossRefPubMed

33.

Roelants-van Rijn AM, Groenendaal F, Beek FJA et al (2001) Parenchymal brain injury in the preterm infant: comparison of cranial ultrasound, MRI and neurodevelopmental outcome. Neuropediatrics 32:80–89CrossRefPubMed

34.

Accardo J, Kammann H, Hoon AH (2004) Neuroimaging in cerebral palsy. J Pediatr 145:S19–S27CrossRefPubMed

35.

van de Bor M, Den OL, Guit GL (1992) Value of cranial ultrasound and magnetic resonance imaging in predicting neurodevelopmental outcome in preterm infants. Pediatrics 90:196–199PubMed

Title: Predictability of cerebral palsy and its characteristics through neonatal cranial ultrasound in a high-risk NICU population
Authors: Eveline Himpens
Ann Oostra
Inge Franki
Georges Van Maele
Piet Vanhaesebrouck
Christine Van den Broeck
Publication date: 01-10-2010
Publisher: Springer-Verlag
Published in: European Journal of Pediatrics / Issue 10/2010
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI: https://doi.org/10.1007/s00431-010-1207-6

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Predictability of cerebral palsy and its characteristics through neonatal cranial ultrasound in a high-risk NICU population

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